Refractory Eosinophilic Esophagitis: What to do When the Patient has not Responded to Proton Pump Inhibitors, Steroids and Diet

Alexandra L. Strauss; Gary W. Falk


Curr Opin Gastroenterol. 2022;38(4):395-401. 

In This Article

What are the Rates of Nonresponse to Current Therapy?

In order to understand refractory EoE, it is critical to understand the response rates to each of the current first-line treatments. The AGA/JTF performed the most recent systematic review that evaluated histologic response rates to therapy, defined as less than 15 eos/hpf at 8 weeks (Table 1). The pooled histologic response rate from 23 observational studies of PPI therapy was 41.7%, 64.9% for corticosteroids based on eight double-blind, placebo-controlled RCTs, and 67.9% for empiric SFED from 10 single-arm observational studies.[6] Patients on diets with fewer food groups eliminated had lower rates of remission. As such, it is estimated that 32--58% of patients will fail first-line treatments for EoE.